Active NPI
Ronald D Gardner, PSYD
- Psychologist
- Cave Junction, OR
National Provider Identifier
1306910948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1372
- Practice address
- 25647 Redwood Hwy
Cave Junction, OR 97531-9724 - Phone
- (541) 592-4111
- Fax
- (541) 592-3916
- NPI assigned
- Nov 17, 2006
- Last updated
- May 14, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1372 | OR | Primary |
Addresses
Primary practice location
25647 Redwood Hwy
Cave Junction, OR 97531-9724
Mailing address
PO Box 158
Grants Pass, OR 97528-0012
Phone (541) 592-4111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 127725 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1372 | OR | MD | Naturopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210723200000",
"number": "1306910948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 158",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975280012",
"telephone_number": "541-592-4111",
"fax_number": "541-592-3916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25647 REDWOOD HWY",
"city": "CAVE JUNCTION",
"state": "OR",
"postal_code": "975319724",
"telephone_number": "541-592-4111",
"fax_number": "541-592-3916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "RONALD",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2008-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "1372",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "127725",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cave Junction, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.